Brentwood

Brentwood is a residential service providing personal care for up to 4 people with a learning disability. The service operates from an adapted building with an enclosed garden in a residential area of Sunderland. At the time of inspection there were 4 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. All staff ensured people living in the service were happy with the environment and found ways to promote their independence; their passions and interests were maintained wherever possible. People and relatives were involved in every stage of care planning. Systems and records were in place to ensure people received person-centred, safe care. People were supported safely with medicines. Infection prevention and control practices reflected current guidance.

Right Care

People received kind and compassionate care. People and their relatives were very positive about the care provided. People told us they felt safe and staff had the skills to support them. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. The registered manager had an effective quality assurance system in place. Regular audits and checks were completed. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home. Staff were safely recruited and received an induction followed by training from the provider.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 7 March 2018)

Why we inspected

This inspection was undertaken due to the age of the previous rating. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brentwood on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brentwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to four people with autism or learning disabilities in a house situated in its own grounds with an enclosed garden area. Four people were using the service at the time of the inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

We inspected the service in December 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references. Staffing levels were appropriate to the needs of the people using the service to ensure people had access to the community and recreational activities.

Relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, whistleblowing, and accident and incident policies. Staff had received training in safeguarding and knew how to report any concerns they may have. Medicines were managed safely by staff who were appropriately trained.

Risks to people were assessed on admission and reviewed on a regular basis. Risk assessments were detailed, individualised, and gave staff guidance about how to help keep people safe. People had personal emergency evacuation plans (PEEPs) in place in case of an emergency. The provider had a business continuity plan for staff to follow in case of disruption to the service.

Staff were trained in a range of subjects such as first aid, food hygiene and fire warden training. Staff had also received training to support them to meet the needs of people who used the service, such as autism and specialist communication methods and epilepsy.

Staff supported people to access appropriate healthcare, such as GPs and speech and language therapists. People’s nutritional needs were assessed and their weight was monitored on a regular basis. The provider ensured people were offered a healthy and varied diet.

Staff received regular supervisions and an annual appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged to make choices in everyday decisions. Staff provided support, guidance and care in a dignified manner, showing people respect whilst ensuring privacy when necessary.

Care plans were personalised and contained in-depth information to cover every aspect of the person’s daily needs. Personal preferences, likes and dislikes were acknowledged in care plans to ensure support was individualised to the person. Care plans were reviewed on a regular basis to ensure staff had up to date information.

People enjoyed a varied range of activities both inside and outside the home. The service had positive links with the community with people accessing local educational sites, leisure centres and shops.

The provider had a complaints process in place which was accessible to people in a pictorial format. Relatives felt the provider responded appropriately to any concerns they raised.

The provider had a quality assurance process in place which included regular visits from senior managers. Where necessary actions were set following audits to drive improvement; these were signed off by the registered manager when completed.

Staff felt the registered manager and deputy manager were open, honest and approachable. They confirmed they felt supported and were able to raise concerns with either manager.

Brentwood provides care and support for up to four people who have learning disabilities or autistic spectrum disorders. At the time of the visit three people were using the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is being run.

People had complex needs so not everyone was able to share their views about the service with us, but we spent time with people and observed care and support. We spoke to family members to obtain their views of the service. There were no concerns raised by other health and social care organisations that we contacted prior to the inspection.

Relatives felt involved in decisions about their family members’ care. They described the service as supportive. One relative told us, “Staff are always caring and helpful with [family member], they seem to be more settled here.” We saw good relationships between relatives and staff. Staff knew how to communicate with people in an accessible way using gestures, pictures and sign language.

There were some gaps in daily records, and some records lacked detail. People’s care records and risk assessments showed us that people were encouraged to be independent. We saw support plans included the promotion of life skills to include shopping and cooking. People’s choices were acknowledged wherever possible. Each person had a weekly planner detailing leisure and social activities. Dietary needs were assessed and appropriate diets provided in line with people’s needs and cultural beliefs

People’s health needs were regularly monitored and assessed. The service contacted other health care professionals when necessary, such as GPs and dieticians. We saw that the service supported people to attend educational facilities.

People had individual bedrooms which allowed privacy; these were comfortably furnished in accordance with people’s choices and preferences. Accommodation took into account peoples support needs with the use of assistive technology.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision and Deprivation of Liberty Safeguards (DoLS) to make sure any restrictions were in people’s best interests.

Staff had an understanding of safeguarding and whistleblowing and told us they would speak to

management if they had any concerns. They felt confident that management would listen and act on any concerns they raised.

Recruitment practices at the service were thorough and safe. Staff training was up to date and staff received regular supervision and appraisal. We looked at current and recent staffing rotas for the service. There were enough staff employed to make sure people were supported. Relatives told us their family members had the correct level of staff supporting them in the home and the wider community.

Systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. Relatives told us they knew how to make a complaint. Records were available which showed the service responded to complaints and lessons were learnt from such events.

The service had a quality assurance system in place. Regular audits were carried out by the registered manager and operations manager. A development plan was in place for service improvements.

Policies and procedures were in place to ensure medicines were managed in a safe way. Records were up to date with no gaps. A signature sheet was in place to indicate who was able to administer medicines. Medicines were counted and recorded on a daily basis as part of the audit process.

We found that the people who used the service were receiving the care and support they needed. For example, the staff we spoke with could describe how they met the assessed needs of the person they were providing with care.

We found that the people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if they suspected anyone was at risk of abuse.

We found that the provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

The complaints procedures had been made available to the people who had used the service and their relatives. This was provided in a format that met their needs.

We found that records, which the provider is required to keep, to protect the peoples' safety and wellbeing, were being stored securely and could be located promptly when needed. For example, the care records were kept in secure cabinets.